Perform CPR Queensland Ambulance Service: Perform CPR Course eLearning program By Beyondedge Queensland Ambulance Service – Apply First Aid eLearning program 1 Perform CPR Table of Contents Table of Contents ................................................................................................... 2 Lesson 1 ................................................................................................................. 4 Lesson 1 cont’d ...................................................................................................... 5 Lesson 1.1 – Introduction to First Aid ............................................................................. 6 Lesson 1.2 – Legal Considerations .................................................................................. 7 Lesson 1.3 – First Aid Equipment .................................................................................. 10 Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance ........................... 10 Lesson 1.4 – Communicable Diseases ........................................................................... 11 Lesson 1.4 – (Interactive Activity) – Communicable Diseases ....................................... 13 Chapter 2 ............................................................................................................. 14 Lesson 2.1 – Recognizing an Emergency ....................................................................... 14 Lesson 2.2 – Emergency Action Plan ............................................................................. 14 Lesson 2.3 – Priorities At The Scene of a Road Accident ............................................... 18 Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident ........................ 19 Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident .............. 20 Chapter 3 ............................................................................................................. 22 Lesson 3.1 – Danger ..................................................................................................... 22 Lesson 3.2 – Response ................................................................................................. 23 Lesson 3.3 – Send For Help ........................................................................................... 24 Lesson 3.4 – Airway ..................................................................................................... 25 Lesson 3.5 – Breathing ................................................................................................. 26 Lesson 3.7 – Defibrillation ............................................................................................ 28 Lesson 3.8 – Life Threatening Bleeding ......................................................................... 29 Lesson 3.8 – (Helpful Hints) – Severe Bleeding ............................................................. 30 Chapter 4 ............................................................................................................. 32 Lesson 4.1 – Questioning The Casualty & Witnesses .................................................... 32 Lesson 4.2 – Checking the Casualty’s Vital Signs ........................................................... 33 Lesson 4.3 – Head–To–Toe Examination ...................................................................... 35 Lesson 4.3 – (Interactive Activity) – Head–to–toe examination .................................... 37 Lesson 4.3 – (Helpful Hints) – The importance of the secondary survey ........................ 38 Chapter 5 ............................................................................................................. 40 Lesson 5.1 – Chain Of Survival ...................................................................................... 40 Lesson 5.1 – (Interactive Activity) – Chain of Survival ................................................... 41 Lesson 5.2 – What is CPR? ............................................................................................ 42 Lesson 5.2 – (Helpful Hints) – What is CPR? .................................................................. 42 Lesson 5.3 – How Do I Do CPR? .................................................................................... 43 Lesson 5.3 – (Interactive Activity) – How do you perform CPR? .................................... 46 Queensland Ambulance Service – Apply First Aid eLearning program 2 Perform CPR Lesson 5.3 – (Helpful Hints) – Recovery position .......................................................... 47 Lesson 5.4 – FAQ’s About CPR ...................................................................................... 48 Lesson 5.5 – Introduction to Defibrillation ................................................................... 50 Conclusion ........................................................................................................... 55 Queensland Ambulance Service – Apply First Aid eLearning program 3 Perform CPR Lesson 1 INTRODUCTION – APPLY FIRST AID Hello and welcome to the Queensland Ambulance Service, “Apply First Aid” program. This first aid program will give you crucial information on the theory and practice of first aid. The course consists of two parts: The first involves successful completion of this theory based, interactive and flexible learning program. The second will require you to attend a practical “Apply First Aid” training session conducted by Queensland Ambulance Service to be accredited to perform first aid. One of the benefits of you successfully completing your first aid training is that the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. We hope you enjoy it, and thank you for taking this important step in equipping yourself with the knowledge to save lives. Queensland Ambulance Service – Apply First Aid eLearning program 4 Perform CPR Lesson 1 cont’d INTERACTIVE INSTRUCTIONS Let’s take a moment now to talk about how this program works: I’ll guide you through the various chapters, which contain lessons made up of theory, demonstration videos and interactive components. The grey panel below contains most of the navigation and setting buttons you need to control this eLearning program. After the lesson has completed downloading you can find navigational points by rolling your mouse over the timeline. Cue-­‐tips will be revealed describing the content covered at these particular points. If you ever need to pause or to resume the lesson, use the pause/play button found below the timeline. To move forward in a chapter, click the ‘next’ button found to the right of the play/pause button. If you didn’t quite understand what was just covered you can always use the ‘back’ button found to the left of the play button. The next button labelled with the speaker icon allows you to adjust the volume. To quickly navigate to a specific lesson or chapter, use the menu button found on the bottom left. Here you make your selection from the pop up menu – this is great for when you need to revise a particular topic. If you ever need to exit or close the program down, make sure to only use the ‘ EXIT’ button found on the bottom right hand side. This will ensure that your progress is recorded so when you log-­‐on again you can continue where you had left off. If this is the first time you’ve used this interactive course, it is recommended you progress in a sequential manner, that is, do one lesson at a time in the order that they appear. Along the way, I’ll give you some fun interactive activities to help you engage with & apply the information you’ve learnt. At the end of each chapter, there will be a quiz to help test your knowledge… so feel free to take notes or to review the chapter to make sure you understand each one before moving ahead. Queensland Ambulance Service – Apply First Aid eLearning program 5 Perform CPR As you progress through the course, you’ll unlock a number of ‘helpful hints’ – these helpful hints will give you useful insights, advice and personal experiences from people who know their stuff. On successful completion of all chapters and assessment quizzes, you’ll need to print out a theory completion record for this part of your course. This record will allow you to progress to the practical training part of the course. If you missed something in these instructions remember you can click back to replay what was just covered. OK, now that you know how to use and navigate this course. Let’s get started. Lesson 1.1 – Introduction to First Aid INTRODUCTION Hello and welcome to Chapter One. In this chapter you’ll learn about the general principals of First Aid, including legal considerations, first aid equipment and communicable diseases. Don’t forget: There will be a quiz at the end, so take your time and make sure you understand each lesson before progressing forward. In this course, we will refer to the ill or injured person as the casualty; or sometimes, we’ll ask Frank to assist – he’s our stand–in for the casualty. Say hello Frank. Frank has the unique ability to turn transparent to show you how first aid can have a direct positive medical impact to your casualty. Frank will also volunteer his services in some interactive activities, which we will talk about later. Thanks Frank. Also, throughout this course we will refer to ‘you’ as the ‘first aid provider’. Let’s start with understanding the basics. Firstly, what is First Aid? Well, as the name suggests, First Aid is the earliest care given to someone who is ill or injured. It can be administered by anyone with proper training, from an ordinary person to more advanced medical practitioners, like doctors, nurses and paramedics. For minor incidents, First Aid may be all that is required to assist a full recovery. In more serious situations, First Aid can greatly increase the chances of a positive outcome for casualties. Queensland Ambulance Service – Apply First Aid eLearning program 6 Perform CPR Ok, so why do we need to know first aid? Well, the primary objective of First Aid is to: • Preserve life • Protect the unconscious • Prevent a casualty’s condition from becoming worse and • Promoting the recovery of the casualty You should aim to prevent: • Damage to yourself or bystanders • Make sure the casualty’s condition does not worsen • Avoid delays that could affect the casualty’s recovery and • Protect the casualty from harmful intervention. First Aid can take many forms, such as reassuring a casualty, treating the casualty and contacting the ambulance service. In critical situations, it may involve giving cardiopulmonary resuscitation (or CPR) – all of which may help to save a life. In emergency situations, it is often the quick but simple actions of someone applying First Aid that ensures a casualty has the best chance of making a full recovery. Although there is no way of anticipating an emergency situation, First Aid training is the best preparation you can have in the event that someone becomes ill or injured and requires assistance. RECAP Recaps will appear at the end of every lesson and will give you a list of the keynotes from that lesson. In this lesson: The primary objectives of First Aid are to: • Preserve life • Protect the unconscious • Prevent a casualty’s condition from becoming worse, and • Promoting the recovery of a casualty Lesson 1.2 – Legal Considerations Here you are at the scene of an emergency. Do you know what your legal obligations are? So let’s deal with this issue right now: Queensland Ambulance Service – Apply First Aid eLearning program 7 Perform CPR A common concern that people have about administering First Aid is the risk of legal liability, which could arise from assisting an injured or ill person. It’s important to consider all the legal implications in some detail, so that you do not feel apprehensive about offering assistance. Once you know how the law works, you should feel confident in your approach to situations that require First Aid. It should be noted that in Australia to date, there has never been any successful legal action brought against someone who was trying to administer First Aid to a person in need. Therefore, when you work within the guidelines of your current first aid training and act carefully with full and proper consideration for the welfare of the casualty, you should feel confident in applying first aid. Remember, in life threatening situations, any form of assistance is likely to be of greater benefit than no assistance at all. One of the benefits of you successfully completing your first aid training with the Queensland Ambulance Service is the statement of attainment provides liability insurance protection. This insurance protects you in the highly unlikely event of litigation following first aid intervention. Here are some basic legal expectations you should know and comply with. Before administering first aid, you must obtain the consent of the casualty to begin first aid. This is to preserve their right to refuse any unwanted form of personal contact. A casualty’s consent is valid when: • Their decision is made voluntarily • Their decision is informed • Their decision covers the first aid treatment to be performed, and • They have the capacity to provide consent. It is not uncommon to come across a person who, due to injury or illness, is unable to consent to the first aid treatment being offered. Lets talk about ‘Capacity to consent’ in some detail: People who are considered to lack adequate capacity to provide consent include: • A person who has diminished ability to understand or communicate the nature and consequences of their decision, for example, a casualty who is unconscious or confused. Queensland Ambulance Service – Apply First Aid eLearning program 8 Perform CPR A minor, who in Australia or New Zealand is someone under 18 years of age If you do not live in these countries, please check your local laws for information on the age limit of minors. If the casualty is a minor, then attempt to get permission from their parent or guardian to apply first aid. If they are not with the minor, or treatment will be delayed whilst seeking their consent, then consent can be inferred. However, it is important to remember, if a casualty cannot provide direct consent and First Aid could prevent death or serious injury, then the general principals governing consent may not apply, as it assumed the casualty would agree to being helped. For some employees with First Aid training, it is expected that they will offer assistance to their workmates should the need arise. This was known as “duty of care” but is now referred to as obligation. It is expected that you will always operate within the guidelines of their first aid training and with consideration for the welfare of the casualty. Under Australian law, a First Aid provider is not compelled to render assistance unless they are under obligation. In accordance with Queensland law, there is an obligation imposed on the driver of a motor vehicle involved in a road traffic crash. They are required to: • Stop at the scene • Render any assistance to the best of their ability and • Call for medical assistance If you decide to provide assistance, you are then obligated to continue the treatment until: The casualty recovers, more advanced carers arrive, the accident scene becomes a danger to you or the casualty refuses treatment. A breach of obligation occurs when you as a First Aid provider fails to act in accordance to your first aid training. It can be determined that you have breached your obligation of care if you have provided first aid outside of the limits of your first aid training and you have not remained with the casualty until more experienced medical care arrives. These expectations may be affected, however, by the conditions and circumstances by which the first aid care is provided. Allowance maybe made for the particular stress of a situation. For example, the expectation of a single first aid provider at a multi casualty incident may be different to the provision of first aid to a single casualty. •
Queensland Ambulance Service – Apply First Aid eLearning program 9 Perform CPR RECAP So, in summary, the legal expectations of you as a First Aid provider is: • To obtain consent of the ill or injured, where possible and • To render assistance carefully, having regard for their level of skill and the circumstances in which they have rendered assistance. Lesson 1.3 – First Aid Equipment Okay, so now that you understand what First Aid is and the legal aspects you need to consider, let’s take a look at some of the equipment you are likely to use. The most common accessory is a First Aid kit, and having one on hand means you will always be prepared to respond to accidents and emergency situations. First Aid can be performed with whatever equipment is available. Ideally a first aid kit, with sterile supplies and a variety of dressings and bandages however, in an emergency situation you may need to improvise. For example, you could use a clean towel or a jumper in the treatment of your casualty; which will be better than not using anything at all. In more serious incidents such as cardiac arrest, Automated External Defibrillators (or AED’s) may be required. They are intended to be used by everyday people in the home, workplace and community. An AED is a portable electronic device that assists the heart to regain its normal, healthy rhythm, which is necessary for a casualty to survive cardiac arrest. You may re–start the heart by using a defibrillator to give an electric shock. Defibrillation increases the casualty’s chances of survival when combined with immediate and effective CPR. RECAP Remember, being prepared with first aid equipment is important. So contact the Queensland Ambulance Service for more information on first aid kits, automatic external defibrillators and oxygen resuscitation equipment. Lesson 1.3 – (Helpful Hints) – Call triple zero (000) for an ambulance I’d like to go through some of the questions that are asked when ringing for an Ambulance and to explain to you the importance of why we ask those questions the two first questions that we ask are the most important questions, they are; Where are you? What suburb are you at? Know where your at, where you are so we can send a Ambulance there if you don’t know where you are I can’t send you an Ambulance. The second most important thing is what is the phone number that you are calling from so if the line disconnects, or I need to call you back to get some more details then I’ve got a phone number that I’m able to contact you directly on. Those are the Queensland Ambulance Service – Apply First Aid eLearning program 10 Perform CPR two most important questions without those we cannot get an Ambulance to you, the next question we will ask is what’s the problem tell me exactly what’s happened? We will also ask the age of the patient, will also ask whether they are male of female? Are the conscious? Are they breathing? People often stumble over are they conscious do you have an understanding of what that means that means are they awake are they alert are they able to respond to you in some way and then the next one is are they breathing. The reason why we will go through and ask these different questions is so that we can get the right Ambulance to you with the right skilled paramedic onboard we have paramedics that have different skills and depending on what condition you have will determine what style of paramedic you will get. Lesson 1.4 – Communicable Diseases So, you arrive at the scene of accident and you are ready to administer first aid. But are you aware of the risks posed by communicable diseases? Communicable diseases are diseases that can be spread from one person to another. They may be in the form of bacteria, viruses, fungi, mites or lice. Some examples include: • Colds and flu • Measles or mumps • Various strains of Hepatitis • HIV infection • Herpes, and • Some forms of Meningitis. Communicable diseases are transmitted by the transfer of body fluids and other body micro–organisms, such as: • Blood • Saliva • Vomit • Urine, and • Faeces So how are diseases transmitted? Let’s talk about how communicable diseases are spread; which is the means by which communicable diseases can spread between people. Firstly, • Droplet / airborne transmission: This occurs when droplets of fluid escape from the nose or mouth of an infected person during a sneeze or cough. Queensland Ambulance Service – Apply First Aid eLearning program 11 Perform CPR •
Other airborne transmission: This can be a form of droplet transmission, but it can also occur when microorganisms are carried by air currents through ventilation or air conditioning systems. •
Transmission by contact: Viruses and germs can cause infection when contaminated blood or body fluids come into direct contact with skin, eyes or mucous membranes, such as the inside of the mouth or nose. Infection can also occur indirectly by contact with blood–soaked contaminants, such as bandages and clothing. Vector–borne transmission: Contaminated objects, including hypodermic needles, fall within this category, as do living micro–organisms such as mosquitoes. These are referred to as vectors. Examples of vector–borne infections include Malaria, Dengue Fever and Ross River Fever. •
You need to protect yourself and casualties from communicable diseases by minimizing contact with blood and other bodily fluids. There are standard precautions that can be followed to ensure safety, however a good rule of thumb is to treat all blood and bodily fluids as contaminated, and act accordingly. Therefore, wherever possible, you should: • Wear Personal Protective Equipment (PPE) such as gloves, boots and goggles • Avoid contact with objects that may be contaminated • Wash your hands thoroughly with soap and water before and after administering First Aid • Cover your own exposed cuts and grazes with waterproof dressings • Avoid eating, drinking and other forms of hand–to–mouth contact whilst administering first aid • Change gloves before handling different casualties to minimize the possibility of cross–infection between casualties • And seek medical aid as soon as possible if contamination by infected blood or body fluids occurs RECAP Communicable diseases can be spread in a number of ways: • Bodily fluids • Through the air • Through direct contact and • By contaminated objects Queensland Ambulance Service – Apply First Aid eLearning program 12 Perform CPR You should always ensure you wear the right protective clothing and follow proper hygiene procedures. Lesson 1.4 – (Interactive Activity) – Communicable Diseases Welcome to your first activity. Throughout this course, there will be a number of places where you will get a chance to apply your knowledge with an activity. These activities are not assessed – They are just a way for you to check your application of the concepts covered. Now that you’ve learnt about cross infection, let’s take a look at a couple of videos together. Watch the video and notice the First Aid Provider is performing a procedure that increases the risk for cross–contamination Write down any incorrect procedures you notice. Write down any incorrect procedures you notice. Then at the end of the clip, you’ll get a list of possible risks. Use the mouse to tick off all the risks you’ve detected during this scene. You can ‘Pause” the video to write down the risks or simply replay the clip as many times as you like. Depending on your result you may wish to try again. You will then be shown the video showing the correct procedure on how to avoid cross contamination. OK, ready to go? QUIZ
That’s the end of chapter one, so it’s time to take a quiz.
Remember, if you get a question wrong, you can repeat your answer until you get it
correct. You will need to successfully complete all questions in this chapter.
Ready to go?
Queensland Ambulance Service – Apply First Aid eLearning program 13 Perform CPR Chapter 2 Lesson 2.1 – Recognizing an Emergency Hello and welcome to Chapter two. In this chapter you will learn how to recognise an emergency situation, how to formulate an emergency action plan and what the priorities are at the scene of a road accident. The first step in responding to an emergency is to ‘recognise’ there is an emergency situation. An emergency situation is when someone requires immediate medical assistance. This is usually either a medical emergency from a sudden illness, such as someone suffering chest pain, or a traumatic emergency, like someone fracturing their arm after a motor vehicle incident. An emergency can happen anywhere and at anytime, so preparation is the key. Lesson 2.2 – Emergency Action Plan Many variables exist in emergency situations and First Aid treatments could be critical in preventing a casualty’s condition from deteriorating before paramedics arrive at the scene. Knowing in advance just what to do and when to do is the key to helping you to stay calm and manage the initial apprehension you may feel in an emergency. After recognising an emergency situation, a systematic approach must be applied. It’s called an Emergency Action Plan. The steps are as follows: • Surveying the scene • Determining whether the scene is safe • Phoning for help • Assess for life threatening injuries, and • Conducting a secondary survey. By following the steps in the emergency action plan, you are ensuring that the needs of the casualty and the situation are correctly prioritised. It is also less likely that important information about the casualty’s condition, or the emergency will be missed. Ok, so what’s a scene survey? Put simply, it is an overall evaluation of the situation that is made by you before any action is taken to help a casualty. It is mainly concerned with recognising hazards Queensland Ambulance Service – Apply First Aid eLearning program 14 Perform CPR and determining the information that will be required when a call is made to activate ambulance services. So how do we go about surveying a scene? The process of surveying an emergency scene involves: • Determining if the scene is safe • Taking reasonable steps to reduce the risk of existing hazards • Determining what has happened • Determining how many casualties are involved and the nature of their injuries, and • And using bystanders to call for help, if possible Hazards at the scene of an accident or medical emergency are identified and gauged according to the risk they pose to each of the three categories of people likely to be present. In order of priority, these are: • The First Aid provider (that’s you) • Any bystanders • And the casualty It may be the case that you are the only person capable of rendering assistance or calling for help and, as such, you must ensure not to endanger yourself and become an additional casualty. Bystanders should be warned about any dangers and kept at a safe distance to ensure they do not become casualties. Once the scene is considered safe, bystanders can be asked to assist if needed. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing. Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Casualties also pose a danger to the first aid provider with the potential for the transmission of communicable diseases. To reduce the risk of transmission of Queensland Ambulance Service – Apply First Aid eLearning program 15 Perform CPR communicable disease, use proper personal protection when available. You can refer to the previous chapter if you need a refresher. Things to consider if the casualty has to be moved: • Avoid bending or twisting the casualty’s neck and back. Remember, spinal injuries can be aggravated by rough handling. • Try to have three or more bystanders to assist in the support of the head and neck, the chest, the pelvis and limbs. • If no bystanders are present, the first aid provider may need to drag the casualty to safety (either with an ankle drag or arm-­‐shoulder drag depending on the situation). Once it has been determined that the scene is safe, it is important to establish what has actually occurred. If you have not directly witnessed events leading to the emergency, any bystanders should be asked whether they saw what happened. If nobody has witnessed the incident, search for clues to work it out. It is important to have an understanding of how the emergency situation came about in order to know what kind of first aid is most likely to be needed. It will also form the basis of the information that will be provided to paramedics when they arrive. It is important to look thoroughly around the scene of an emergency incident to determine how many casualties are involved. This information will be required by the ambulance service, and will help you to establish priorities. When approaching a scene, look carefully for more than one casualty. At a road traffic accident, always look under the passenger side dash and in the back seat floor area, to ensure that no casualties, particularly small children and infants, have slipped forward off the seats. Also check the surrounding area to ensure that no casualties have been thrown from a vehicle. Use bystanders if possible to help you, or ask them to call triple zero (000) to activate the ambulance service. Bystanders can act as traffic control until the police service arrive, direct emergency services to the scene and assist with the treatment of a casualty. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. Serious cases need qualified medical attention without unnecessary delay. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care. Queensland Ambulance Service – Apply First Aid eLearning program 16 Perform CPR If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to offer other forms of assistance to you once the call for ambulance assistance has been made. For example, conveying any treatment advice that may have been offered by the emergency medical dispatcher receiving their call. When a call is made to the Ambulance Service, a trained emergency medical dispatcher will ask the caller a number of questions. The questions are likely to include the following: • What is the exact location of the incident/accident? • What is the phone number from which you are calling? • What has happened? • How many people are sick/injured? • What is the nature of the casualty’s injuries? • Are you with the casualty now? • How old is the casualty? • Is the casualty conscious? • Is the casualty breathing? Make sure you remain calm and your responses are clear and concise. The emergency medical dispatcher will dispatch the ambulance paramedics and provide you with First Aid advice. Remember not to end the call until you are told to do so by the emergency medical dispatcher. Now let’s look at assessing for life threatening injuries. This step involves the assessment of and response to the casualty’s vital signs and life threatening conditions that could lead to loss of life. The first thing you should check • Is a casualty’s response • Then their airway • And if they are breathing normally. • After these vital signs have been assessed, it is important to then check for any life threatening bleeding. So what is a secondary survey? A secondary survey allows a more thorough and systematic examination of the casualty conditions or injuries that were not initially apparent. Do not commence a secondary survey if any life–threatening conditions are present. You will learn more about how to conduct a secondary survey in Chapter 4. Queensland Ambulance Service – Apply First Aid eLearning program 17 Perform CPR RECAP So, in summary, the Emergency Action Plan is: Survey The Scene • Is the scene safe? • What happened? • How many casualties are there? • Are there any bystanders to help? • Determine whether the scene is safe • For yourself • Bystanders, and • The casualty. Call triple zero and ask for the ambulance service • Listen carefully to the emergency medical dispatcher • Give the exact location • Give the call back phone number • Provide incident details and the casualty’s condition. If possible, send a bystander to make the call. • And remember to hang up last. Assess For Life Threatening Injuries • Response • Airway • Breathing normally • Severe bleeding Conduct A Secondary Survey • Question the casualty and bystanders • Check vital signs • Conduct a head–to–toe examination Lesson 2.3 – Priorities At The Scene of a Road Accident Now that you have learned how to formulate an Emergency Action Plan, let’s have a look at how you can manage a road accident. It’s important to note that one of the biggest life threatening risks to casualties of road accidents is obstruction of their airway. Okay, here’s how you should approach a traffic accident: • Conduct a scene survey. • Determine whether the scene is safe. Queensland Ambulance Service – Apply First Aid eLearning program 18 Perform CPR •
Remove or control any hazards if safe to do so. – This includes turning off the ignition of a crashed vehicle – Warning approaching vehicles – Not touching a vehicle, or attempting to rescue a person from within six metres of a fallen high voltage power line unless the electricity authority has declared the area safe – Warning the casualties and bystanders not to smoke. •
•
•
Determine the number of casualties and the nature of their injuries. Call triple zero for help. Assess and assist the injured casualties – Firstly, go to any unconscious casualties and assess for life threatening injuries. – If the person is unconscious and trapped in the vehicle, the casualty’s airway must be cleared of foreign material, and then head tilt and jaw support should be maintained. – Attending to any conscious casualties – Carefully assist any casualties from the vehicles – Stopping any bleeding – Immobilizing any obvious fractures – Rest and reassuring the casualty, and – Regularly monitoring and recording vital signs, including pulse, breathing, level of consciousness and pupil reaction. RECAP For a road traffic accident you should: • Conduct a scene survey. • Determine whether the scene is safe. • Remove or control any hazards if safe • Determine the number of casualties and the nature of their injuries. • Phone for help. • Assess and assist the injured casualties. • You should always ensure you wear the right protective clothing and follow proper hygienic procedures. Lesson 2.3 – (Helpful Hints) – Priorities at the scene of a road accident Yeah, well if you do come across a motor vehicle accident my advice would be that you stay a safe distance away from the incident; preferable behind the incident two to three vehicle distances away, put your hazard lights on and then approach the scene if it is safe to do so to see if anyone needs assistance. Queensland Ambulance Service – Apply First Aid eLearning program 19 Perform CPR If you’re on a highway or a motorway where there is a fair amount of traffic. If you can the assistance of a truck driver to use his truck as a barrier between the accident scene and oncoming traffic put his hazard lights on and maybe put out his hazard markers further back. That would be the safest way to approach a motor vehicle accident. The information the emergency services would require would be if there was any chemicals involved we need to look for things known as HAZCAM indicators or markers on the trucks in particular. There a diamond shape marker or sign on the truck and all you need to do is quote the numbers that are and the chemicals mentioned to the Ambulance service if you ring them first you also need to check to see how many people were involved in the accident is anybody trapped in particular because will notify the QLD Fire and Rescue Service to also attend and come out with there jaws of life to help extricate the patient from the vehicle. Lesson 2.3 – (Interactive Activity) – Priorities at the scene of a road accident Now that we have learnt all about the hazards at the scene of a road accident it’s time to test your knowledge with another activity. Remember these activities do not count towards your final score, so you can relax. In this activity you required to analyse the accident scene and identify the possible hazards. Simply click on any areas that you think is a priority until you have found them all. Pop-­‐up descriptions will appear when you roll over items. A running tally of how many priorities will need to be found is located below the timer. Don’t forget; you are also racing against the clock, just like you would in real life. If you do run out of time don’t worry you have the option to try again or have all the priorities areas automatically revealed. Ok, Ready to go? QUIZ That’s the end of chapter two, so it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Queensland Ambulance Service – Apply First Aid eLearning program 20 Perform CPR Ready to go? Queensland Ambulance Service – Apply First Aid eLearning program 21 Perform CPR Chapter 3 INTRODUCTION Hello and welcome to chapter 3. In this chapter you will learn how to assess for life threatening injuries using the steps of the basic life support flowchart. A life-­‐threatening injury is an injury that could possibly be fatal to the casualty if first aid is not applied as soon as possible. As you arrive at the scene of an incident you should remember the following steps by using the acronym D.R.S.A.B.C.D or Doctors A.B.C.D. That stands for: 1. Danger 2. Response 3. Send for Help 4. Airway 5. Breathing 6. CPR 7. Defibrillation These steps, as well as how to treat life-­‐threatening bleeding, will be covered in more detail throughout the chapter. Lesson 3.1 – Danger The first step after arriving at an emergency situation is to assess the incident for DANGER, as discussed earlier in Chapter Two. It is important to survey the scene and determine whether there are any dangers or hazards to you, the casualties or any bystanders. The kinds of danger that need to be considered at an emergency scene can take many forms, such as traffic, used syringes, fallen power lines, fire, extreme weather, leaking fuel or gas, toxic fumes, unstable structures, bodies of water, poisonous substances, dangerous animals and the unpredictable actions of bystanders. Any hazards that may be present should be removed or controlled in such a way that will prevent further injuries, but only if it is safe to do so. It is also a good idea at this point to have a quick look around to ensure that there are no dangers developing. Queensland Ambulance Service – Apply First Aid eLearning program 22 Perform CPR Situations involving hazards that are not easily controlled should be left for the attention and management of emergency service personnel who have the specialised training and equipment necessary to deal with them safely. Once the incident has been deemed safe, you can begin to start assessing the casualty for life-­‐threatening injuries using the RESPONSE method. RECAP So remember: Check for DANGER • Your safety is the first priority so survey the scene for dangers and developing dangers before attending to casualties. • Only remove hazards if it is safe to do so, otherwise, leave it for emergency services personnel Lesson 3.2 – Response The first step in assessing for life–threatening injuries is to determine the casualty’s level of consciousness, often indicated by their ability to respond. Initially, this should be done through the “talk and touch” method, ensuring that you do not aggravate any injuries. You should never shake casualties when checking for their response, especially infants or children. Checking for a response should only incorporate gentle touching and loud talking. A good way to remember the questions and directives that enable you to assess response is the acronym COWS: – Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands There are three levels of consciousness: • Conscious: A state in which a person responds normally to questions and requests, such as those relating to the day, date, time and where they are • Altered level of conscious: Queensland Ambulance Service – Apply First Aid eLearning program 23 Perform CPR •
A state in which a person responds to questions in a way that indicates they may be confused, disoriented, have altered thinking or a marked impairment of awareness Unconscious: A state in which a person is not able to respond at all A casualty who responds normally is conscious and breathing. At this point, you should identify yourself and obtain consent to apply first aid. It’s a good idea to ask the casualty their name, as using it will reassure them while you assess their injuries. A casualty who does not respond could be unconscious and, if so, is likely to be in a life–threatening situation. The two main concerns for an unconscious casualty are that they are unable to protect themselves from any danger and that they are unable to manage their own airway. When the respiratory system is not functioning effectively there is a disruption in the supply of oxygen to the brain. This can lead to unconsciousness in a few seconds and permanent brain damage in just minutes. If the casualty is unresponsive, call triple zero to request ambulance assistance, then assess for a clear airway and whether or not the casualty is breathing normally. RECAP So to recap: Check responsive; use the COWS method: – Can you hear me? – Open your eyes – What’s your name? – Squeeze my hands Three Levels of Consciousness: • Conscious – responds normally to questions and requests • Altered level of conscious – responses to questions indicate they may be confused and disoriented • Unconscious – a state in which a person is not able to respond at all Lesson 3.3 – Send For Help Once you have identified that the casualty is in a life-­‐threatening situation, you must call triple zero (000) immediately for assistance. Queensland Ambulance Service – Apply First Aid eLearning program 24 Perform CPR In any emergency situation involving sudden illness or injury, it is essential that the ambulance service be contacted as soon as possible. Remember, First Aid is interim assistance until more advanced medical care can be provided. In some circumstances, such as emergency situations at which bystanders are present, it is possible to call for an ambulance prior to determining whether the scene is safe. By getting a bystander to call triple zero for an ambulance, it enables you to remain with the casualty and provide ongoing care. If the person making the call to the ambulance service has to leave the scene, it is important that they know to report back once the call is made. They may be able to offer other forms of assistance to you once the call for ambulance assistance has been made. If there are no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. RECAP So to recap, remember: • Send for Help • First Aid is only interim assistance so it is essential to call 000 for assistance. • If possible, get a bystander to call triple zero for an ambulance as it enables you to remain with the casualty and provide ongoing care. • And if there is no bystanders immediately present, you can shout out to try and attract the attention of someone who can help you. Lesson 3.4 – Airway Now that you’ve learned how to check for response, it is important to learn how to check a casualty’s airway. Start by looking in the mouth for foreign bodies such as food, loose dentures or fluid. DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Let me repeat that: DO NOT TILT THE HEAD BACK UNTIL THE MOUTH IS CLEARED OF ANY FOREIGN MATERIAL. Otherwise, you risk blocking the airway with this foreign material. Queensland Ambulance Service – Apply First Aid eLearning program 25 Perform CPR Dentures should only be removed if loose or if they could possibly cause an airway obstruction. If secure, leave the dentures in place as it will help to ensure a good seal if rescue breathing is necessary. If water, vomit, blood or other fluid obstructs a casualty’s airway, place the casualty in the recovery (or side) position, sometimes referred to as the lateral position, which results in a sideways, slight downward tilting of their face. This position uses gravity to move the tongue away from the airway and assists with the draining of liquids from the mouth and also allows you to use the finger–sweep technique to clear the airway. The finger–sweep technique utilises the index and middle fingers to perform a sweeping action in the casualty’s mouth to remove the foreign body. And remember, do not probe during the process of clearing an airway, as it may push foreign material further into the airway and make it more difficult to clear. RECAP So let’s recap: • Check the airway • First check for foreign bodies in the casualty’s mouth • Do not tilt the head back until the mouth is clear of any foreign material • Clear the mouth using finger sweep technique • Do not probe during the process of clearing the airway Lesson 3.5 – Breathing The next step in the basic life support process is breathing. Once it is established that the casualty’s airway is clear, you should then check if they are breathing normally. This is done through the look, listen and feel technique: – Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek. If the casualty is breathing normally, and not already in the lateral or recovery position, then move them into this position, taking great care to avoid twisting the head, neck or spine. Remember, establishing and maintaining a clear airway always takes precedence over any injury, including a suspected spinal injury. To move someone into recovery position: Queensland Ambulance Service – Apply First Aid eLearning program 26 Perform CPR Move the casualty’s arm that is furthest away from you out to the side of the casualty • Place the casualty’s arm that’s closest to you over the casualty’s chest • Lift the casualty’s leg by bending the knee that’s closest to you. • Grasp the casualty’s shoulder that’s closest to you and place the other hand on the casualties hip • Gently roll the casualty away from you, keeping the casualties head, neck and spine straight • Position the casualty so their hand and bent knee supports them in the recovery position, and • Gently tilt the casualty’s head slightly back and downwards to allow for drainage While the casualty is on their side in the recovery position, it is important to regularly check their airway and breathing. You should then immediately check for any life threatening bleeding. If any life threatening bleeding is found, then control it immediately. You should also commence a secondary survey while you wait for paramedics to arrive. RECAP So to recap, to check for breathing you: – Look for the rise and fall of the chest by placing your hand on the casualty’s stomach – Listen for the movement of air by placing your ear near their nose and mouth – Feel for the movement of air from the nose and mouth against your cheek To move someone into recovery position: • Move the casualty’s arm that is furthest away from you out to the side of the casualty • Place the casualty’s arm that’s closest to you over the casualty’s chest • Lift the casualty’s leg by bending the knee that’s closest to you. • Grasp the casualty’s shoulder that’s closest to you and place the other hand on the casualty’s hip • Gently roll the casualty away from you, keeping the casualties head, neck and spine straight • Position the casualty so their hand and bent knee supports them in the recovery position, and • Gently tilt the casualty’s head slightly back and downward to allow for drainage •
Queensland Ambulance Service – Apply First Aid eLearning program 27 Perform CPR Lesson 3.6 -­‐ CPR The next step in the D.R.S.A.B.C.D method is CPR or Cardiopulmonary resuscitation. If you have determined that the casualty is not breathing normally and is unresponsive it means they are in cardiac arrest and you will need to commence CPR as soon as possible. CPR requires the First Aid Provider to administer 30 chest compressions at a rate of 100 compressions per minute followed by 2 rescue breaths to the casualty. These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself. If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing. It’s a good idea, if available, to have two people performing CPR on a casualty, as to prevent fatigue of the first aid provider. RECAP • If the casualty is not breathing normally and is unresponsive, commence CPR as soon as possible. • CPR requires 30 chest compressions followed by 2 rescue breaths to the casualty. • These are to be repeated until paramedics can take over, the casualty becomes responsive and starts breathing normally, it becomes impossible for you to continue or there is a danger to yourself. • If the casualty starts breathing normally but remains unresponsive, roll them into the recovery position and monitor their breathing. Lesson 3.7 – Defibrillation Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest. The sooner defibrillation is attempted, the more likely a positive result will occur. For every minute a defibrillator is not used, the casualty’s chances of survival decreases by 10% An Automated External Defibrillator or AED as they are commonly known, have been developed for use by laypersons. The AED gives out easy to follow voice prompts and Queensland Ambulance Service – Apply First Aid eLearning program 28 Perform CPR picture instructions for its use. If you have determined the casualty is in cardiac arrest and have access to an AED, use it in conjunction with CPR If you do not have an AED available, continue CPR until an emergency medical professional arrives or signs of life return, as the paramedics will be equipped with a defibrillator How to use an AED will be discussed further in Chapter 5. RECAP So to recap, remember: • Defibrillation is the best possible chance to resuscitate someone who is in cardiac arrest • An Automated External Defibrillator or AED has been developed for use by laypersons. • If you have determined the casualty is in cardiac arrest and have access to an AED it is best to use it before commencing CPR. • If you do not have an AED available, continue CPR until an emergency medical professional arrives, as they will have a defibrillator with them Lesson 3.8 – Life Threatening Bleeding The final lesson in this chapter is about life threatening bleeding. You should identify and immediately control any life threatening bleeding. This simply requires the casualty to be scanned from head–to–toe to detect signs of external bleeding. Bleeding is considered life threatening when it is spurting or cannot be controlled and must be treated as quickly as possible. This is the recommended treatment for life threatening bleeding: • Rest and reassure the casualty • Call Triple Zero for an ambulance immediately • Ensure you wear the correct personal protective equipment. • Apply pressure to the wound using a pad and bandage. • Elevate the wound if possible. • Regularly monitor and record the casualty’s vital signs. • Reassure and calm the casualty until paramedics arrive. RECAP So to recap, the important points to remember when assessing and attending to casualties with life-­‐threatening injuries are: Queensland Ambulance Service – Apply First Aid eLearning program 29 Perform CPR •
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D for DANGER Check for hazards that could possibly harm yourself, bystanders or the casualty R for RESPONSE Once the area is safe, check the casualty for a response. S for SEND FOR HELP If the casualty is unresponsive, send for help by either calling 000 yourself or by asking a bystander to call for you. A for AIRWAY Check and clear the airway of the casualty of any foreign bodies. B for BREATHING Check the casualty is breathing by using the Look, Listen and Feel method. C -­‐ CPR If the casualty is not breathing, commence CPR by administering 30 chest compressions followed by 2 rescue breaths. Continue until help arrives. D for DEFIBRILLATION If available, use an AED and commence defibrillation on the casualty in cardiac arrest. IF LIFE-­‐THREATENING BLEEDING is identified then it should be controlled by: • Resting and reassuring the casualty • Calling Triple Zero for an ambulance immediately • Ensuring you wear the correct personal protective equipment. • Applying pressure to the wound using a pad and bandage. • Elevating the wound if possible. • Regularly monitoring and recording the casualty’s vital signs. • Reassuring and calming the casualty until paramedics arrive. Lesson 3.8 – (Helpful Hints) – Severe Bleeding In severe bleeding from an Ambulance perspective we would like to ask the patient if/or the bystander if they could perhaps find a clean towel or a blanket or a nice clean shirt of some sort relatively we like to keep it dry we would ask that they apply firm but gentle pressure to the area without pushing to much on the open wound its very important that once we do apply that pressure we don’t take the if its a towel or whatever it is we don’t take that away from the wound and will keep that pressure on should bleeding go through the original towel we ask that you get a second object whether it be a still again a blanket or shirt and re–apply that on top of the original blanket or towel that you have. In relation to haemorrhage control I Queensland Ambulance Service – Apply First Aid eLearning program 30 Perform CPR have recently proceeded to a case in the local area to a construction site where on arrival we found that a gentlemen had a circular saw injury which had penetrated his groin on arrival we found that his boss who was on scene who had a towel had applied really great haemorrhage control he put the towel on the sight of injury and didn’t move it until we arrived, there wasn’t a significant haemorrhage loss at this point of time but having that initial haemorrhage control allowed us to then focus on other part of the treatment he remained at that site while we continued re–
assessing the patient he did really well he didn’t remove it the clot remained in place and we were able to give the gentlemen further treatment like fluids to get his blood pressure back up because the haemorrhage was controlled until/or by the time we had got on scene. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go? Queensland Ambulance Service – Apply First Aid eLearning program 31 Perform CPR Chapter 4 INTRODUCTION Hello and welcome to chapter four. In this chapter you will learn how to conduct a secondary survey. This involves questioning the casualty and witnesses, checking the casualty’s vital signs and conducting a head–to–toe examination. A secondary survey is a more comprehensive and systematic assessment of a casualty and is designed to identify any less obvious conditions. The process of a secondary survey involves three steps: • Questioning the casualty and witnesses • Continuing to check vital signs, and • Conducting a head-­‐to-­‐toe examination Lesson 4.1 – Questioning The Casualty & Witnesses Here you are at the scene of an incident. How can you determine how a casualty became ill or injured? The best method is to observe what you see around the incident site and to question the casualty and witnesses. The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty: D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem started and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning When speaking with the casualty, always offer reassurance, this will ease anxiety and stress that can have a negative affect on their condition. If it is difficult to communicate with the casualty, due to unconsciousness, injury, language barriers or age, question any witnesses or bystanders to establish the history of the incident. If there are no witnesses, your only option will be to make your own observations about the casualty and the incident site. RECAP Queensland Ambulance Service – Apply First Aid eLearning program 32 Perform CPR The term DOLOR is used to remind first aid providers of some simple questions that could be asked of a casualty: D – description: ask the casualty to describe the problem O – onset and duration: ask the casualty when the problem arose and how it progressed L – location: ask the casualty where on the body the problem is O – other signs and symptoms: do you notice any other signs or is the casualty aware of other symptoms? R – relief: has anything provided relief. For example, rest, medication, positioning Lesson 4.2 – Checking the Casualty’s Vital Signs So, having questioned the casualty and witnesses, you may have a clear picture of how the incident occurred. The next step in the process is to check the casualty’s vital signs. These are indicators of whether the body is acting normally or if it’s trying to make adjustments due to injury or illness. Vital signs are: • Conscious level • Breathing • Pulse, and • Skin Colour You need to pay close attention to vital signs, checking and recording them regularly until the paramedics arrive. Adults at rest breathe between 12 and 18 times per minute. Children at rest between 1 and 8 years old breathe slightly faster at 15 to 30 times per minute. Infants at rest under 1 year can breathe 25 to 50 times per minute. You need to regularly check for any change to a casualty’s breathing which could indicate their condition is improving or declining. Signs of abnormal breathing include: • Gasping • Noisy breathing, such as wheezing or gurgling • Breathing that is excessively fast or slow • Pain when breathing. Every time the heart contracts, it forces blood around the body through the circulatory system. This is referred to as a person’s pulse. If a pulse is present, it may be felt by placing two fingers over one of the radial arteries in the wrist, or over the carotid artery in the neck. Queensland Ambulance Service – Apply First Aid eLearning program 33 Perform CPR A normal resting pulse rate for adults is generally between 60 to 100 beats per minute. A normal resting pulse rate for children is generally between 70 and 140 beats per minute, while infants under 1 year of age are usually 90 to 160 beats per minute. A change in someone’s normal pulse rate could indicate an improvement or worsening in their condition and can be indicated by: • Irregularity • Weakness • A pulse that is too fast or too slow. If the casualty is in shock due to blood loss, the radial pulse might be hard to find as the body redirects blood from the extremities to vital organs. In this instance, feel for a pulse in the neck and remember if they’re breathing then they must have pulse. To check for a casualty’s radial pulse: • Turn the casualty’s hand palm–side up, and then place your two fingers along the outer edge of the casualty’s wrist just above where their wrist and thumb meet. • Slide your fingers toward the centre of the casualty’s wrist. You should feel the pulse between the wrist bone and the tendon. • Press down with your fingers until you feel the casualty’s pulse. Do not press too hard, or you will not be able to feel the pulsation. • Continue to feel the pulse for a full minute. • Record this pulse rate and the time it was taken. To check for a casualty’s neck pulse: • Gently tilt the casualty’s jaw upwards, and place your first two fingers of your hand at the casualty’s chin. • Move your fingertips gently downwards along the windpipe and throat. • Press down with your fingers until you feel the casualty’s pulse. Do not press too hard, or you will not be able to feel the pulsation. • Continue to feel the pulse for a full minute. • Record this pulse rate and the time it was taken. The last vital sign to check is skin colour, as it can give critical early clues about their condition. A casualty who is suffering from shock from blood loss may be sweaty and will have pale skin that is cool to touch. This is because the body redirects blood away from the skin’s surface to support the functioning of the vital organs. Whereas flushed (very red) skin could indicate to high blood pressure or suffering an allergic reaction. Queensland Ambulance Service – Apply First Aid eLearning program 34 Perform CPR RECAP Vital signs are indicators of whether the body is functioning normally or if it’s trying to make adjustments due to injury or illness. Vital signs are: • Conscious level • Breathing • Pulse, and • Skin Colour You need to pay close attention to vital signs, checking and recording them regularly. Lesson 4.3 – Head–To–Toe Examination The final lesson in this chapter is the head–to–toe examination. This is a step–by–
step search for any injuries that are yet to be identified. It prioritises the more serious injury locations. These injuries should be treated in the order in which they are found. The sequence is: • Head • Neck • Chest or back • Abdomen • Pelvic area • Legs • Arms Obviously, it will not always be necessary to carry out a head–to–toe examination. The types of injury it is useful to identify include minor bleeds, bruising over internal organs that could indicate internal bleeding and deformities that could indicate fractures. It may also locate a medic alert tag that will help you be aware of a casualty’s existing medical condition. You should avoid any unnecessary contact with obviously injured parts of the body. Watching a casualty’s facial expressions is a good gauge for any discomfort they might be in. For thoroughness, check both left and right, front and back of the body. HEAD When starting at the head you should look and gently feel for: • Moist areas on the scalp, which could be blood • Blood or fluid from the nose or ears, which could indicate a skull fracture • Foreign objects in the eye • Pupils that are significantly different in size, which could indicate a brain injury or stroke Queensland Ambulance Service – Apply First Aid eLearning program 35 Perform CPR •
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Evidence of a fracture or dislocation of the jaw Symmetry in the face. If one side of the face is drooping or is less controlled than the other, it could be indicative of a stroke. Blood or loose teeth in the mouth, which could cause airway problems. NECK When checking the neck, if the casualty is complaining of neck pain, do not allow the casualty to move their head or neck. Gently feel along the top part of the spine for any irregularities or deformities and visually inspect the windpipe for bruising, swelling and other marks. CHEST or BACK When examining the chest, the most important thing to look out for is that both sides of the chest move equally when the casualty breathes. Have them take a few deep breaths and look for: • Any part of the chest that does not rise when the casualty breathes in, which could indicate a number of fractured ribs • Any wounds, particularly those that make a sucking sound • Bruising, which could indicate internal injuries. You should then check the casualty’s back for bleeding or any other abnormalities. If spinal injuries are not suspected, gently roll the casualty onto their side to assess the back. ABDOMEN You should look and/or gently feel for the following: • Unusual swelling or marks • A hard or rigid abdomen, which could indicate severe internal bleeding • Bruising. If there is pain, ask the casualty to show you where it is situated and note the location. Also ask the casualty to rate the intensity of the pain on a scale of 1 to 10, with 1 being the slightest of pain and 10 being the severest. PELVIC AREA You should look for visible signs of any life threatening bleeding in or around the pelvic area. If life-­‐threatening bleeding is apparent, there may be a need to remove parts of clothing to identify and treat the injury. LEGS Queensland Ambulance Service – Apply First Aid eLearning program 36 Perform CPR You should look and/or gently feel for any bleeding, deformity or bruising on either leg. If no deformity is evident, place your hand under the soles of the casualty’s feet and ask them to push against your hand. Then reverse this process by putting your hand on top of the casualty’s feet and asking them to pull against it. This will help determine whether there are any obvious weaknesses on one side of the body or the other, which could indicate that the casualty has suffered a stroke. ARMS You should look and/or gently feel for any bleeding, deformity or bruising on either arm. If no deformity is evident, ask the casualty to squeeze both your hands. As with the leg examination, this will help to determine if there are any obvious weaknesses on one side of the body or the other, which could indicate that the casualty has suffered a stroke. Continue to monitor the casualty’s level of consciousness, breathing, pulse and skin colour throughout the examination process. If any problems relating to these vital signs become apparent, stop the secondary survey and address them immediately. If the casualty does not have a life threatening condition and the head to toe examination reveals no other significant injury, this would be a good opportunity to record their full name and date of birth, documenting their injuries, condition and the treatment steps that have been instigated. When the Paramedics, they may ask a first aid provider for information about the casualty’s medical and incident history to assist their understanding of the situation. RECAP A head–to–toe examination is step–by–step search for any injuries that are yet to be identified. The sequence is: • Head • Neck • Chest or back • Abdomen • Pelvic area • Legs • Arms Lesson 4.3 – (Interactive Activity) – Head–to–toe examination As you have just learnt, it is important to treat a casualty’s injuries in the right order of priority in a head-­‐to-­‐toe examination. Queensland Ambulance Service – Apply First Aid eLearning program 37 Perform CPR Click on the number one pin, drag and drop it onto the first part of the body you would check in a head-­‐to-­‐toe examination. Here’s a tip for you, drag the number one pin onto the casualty’s head to start with, then decide which area should be examined next by dragging the number two pin to that area of the body and so on. The numbers indicate the correct order the casualty should be examined. If you place a pin in the wrong order, it will simply not stick, so you will need to try a different area. Don’t forget, you are racing against the clock on this one too, so do it as quickly as you can. Ready to start? Lesson 4.3 – (Helpful Hints) – The importance of the secondary survey Our secondary survey is important as it does allow you to identify any further injuries or complications that might of happened when the patient has been injured but we can’t take the focus of the initial survey from a paramedics point of view it allows you to identify life threatening conditions or things that are going to cause this patient to be in harms way so your airway your breathing and your circulation are most important because they are 3 areas that are going to cause the greatest problems if they aren’t addressed so in your airway we appreciate that you roll them on there side keep the airway clear with there breathing, with there breathing keep monitoring their airway, tilt there head back and then go onto there circulation they do have a pulse just keep re–assessing them, if they don’t have a pulse commence CPR and just in that initial ABC look for your any uncontrolled haemorrhage that may be in place. In the past I have attended a case in Queen St mall where a gentleman has collapsed in a very public area. They made a triple “0” call (000) to our call centre here and the patient on questioning was realised that they were in cardiac arrest the bystanders did a very good job of following their initial primary survey which was the ABC’s they cleared the airway started CPR and commenced CPR until we arrived. It is important to realise that yes there might be additional injuries but we would like you to focus more on their airway, breathing and circulation because we can address those other injuries when we get there but it is good to point out that if you do notice any thing in a secondary survey that let us know when we do get on scene because we can treat that as well once we address the primary initial survey. QUIZ Queensland Ambulance Service – Apply First Aid eLearning program 38 Perform CPR Well that’s the end of this chapter; you’re doing really well, but it’s time to take a quiz. Now remember, if you get a question wrong, you can repeat your answer until you get it correct. As you know by now, you will need to successfully complete all questions in this chapter. Are ready to go? Queensland Ambulance Service – Apply First Aid eLearning program 39 Perform CPR Chapter 5 INTRODUCTION Hello and welcome to this crucial chapter on CPR. In this chapter you will learn about cardiopulmonary resuscitation or CPR. Don’t forget to take the quiz and remember to check out the demonstration videos that show you how to administer CPR correctly to an adult, child and infant. CPR is a vital, life saving skill that every person should know. Learning how to effectively perform CPR can prepare you to respond in the event you observe a cardiac arrest. Cardiac arrest occurs when the heart stops beating. A person who suffers a cardiac arrest will be unconscious and show no signs of life. Cardiac arrest may occur at any age from various causes, but the most common is heart disease. To be prepared to respond to a cardiac arrest appropriately and effectively, you need to know how to call triple zero for the ambulance service and how to provide CPR. Lesson 5.1 – Chain Of Survival CHAIN OF SURVIVAL The chain of survival is critical to achieving the successful resuscitation of a casualty in cardiac arrest. Successful resuscitation depends on all links in this chain being activated in a timely way. A delay in the actions specified in any link will significantly decrease a casualty’s chances of survival. Follow the links in the chain and you are well placed to give a casualty, who is in cardiac arrest, vital early treatment. So, what are the links? Link 1 – early recognition Early recognition that a person is suffering from a cardiac condition or is in cardiac arrest is essential. This allows you to commence the vital treatment a casualty requires and to call for an ambulance as soon as possible. Link 2 – early access Early activation of the ambulance service is an essential link in the chain. It will provide the casualty early access to the care that can be provided by paramedics with advanced skills and equipment for a casualty in cardiac arrest. Link 3 – early CPR The timely and effective provision of cardiopulmonary resuscitation (CPR) significantly increases a casualty’s chances of surviving a cardiac arrest. The purpose Queensland Ambulance Service – Apply First Aid eLearning program 40 Perform CPR of CPR is to maintain blood flow and thereby the supply of oxygen to the body’s vital organs until ambulance paramedics can provide more advanced forms of care. Link 4 – early defibrillation Defibrillation is designed to stop certain dangerous heart rhythms and assist the heart to regain a normal rhythm. This will result in effective circulation recommencing to oxygenate the vital organs. The greater the lapse of time before defibrillation is attempted, the less successful it is likely to be. Some public venues, such as service clubs, shopping centres and major sporting grounds, have their own defibrillators and staff trained to use them. Link 5 – early advanced life support or ALS. Queensland Ambulance Service paramedics are trained in the use of, and carry, advanced cardiac drugs to increase the casualty’s chances of survival during resuscitation attempts. If a casualty has been successfully resuscitated by first aid providers, paramedics are able to stabilise them prior to departing for hospital. Link 6 – definitive care Definitive care is available at hospital where higher level of medical care can be provided. Prompt CPR and early defibrillation will increase the chances of survival for a casualty in cardiac arrest. RECAP OK, so let’s recap those links: Link 1 – early recognition Link 2 – early access Link 3 – early CPR Link 4 – early defibrillation Link 5 – early advanced life support or ALS Link 6 – definitive care Lesson 5.1 – (Interactive Activity) – Chain of Survival Welcome to the chain of survival activity. This activity is designed to help you remember the correct order in the chain of survival. Simply drag and drop the links in the chain to arrange them in the correct order. You need to complete the activity within the allocated time, so keep an eye on that timer. Don’t worry if you don’t get them all on the first go, you can try again. Queensland Ambulance Service – Apply First Aid eLearning program 41 Perform CPR So are you ready to start the activity? Lesson 5.2 – What is CPR? If this happened to a loved one, would you know what to do? Could you use CPR to assist them? Firstly, what is CPR? CPR stands for cardiopulmonary resuscitation. “Cardio” refers to the heart and “pulmonary” refers to the lungs. Therefore CPR is about getting oxygenated blood to the brain, heart and other vital organs, of a person who is unable to do it themselves. Without it, they will die. CPR involves pushing on their chest to pump the heart and blowing air into a person’s lungs by mouth–to–mouth resuscitation. CPR should only be performed on someone who’s had a cardiac arrest. If they have, they will appear to be unresponsive and not breathing normally. In this instance, CPR should commence immediately, beginning with chest compressions. There is no specific timeframe for how long you should administer CPR. Keep going until: • The person recovers • A paramedic or health care professional takes over or tells you to stop • It becomes impossible for you to continue, or • There is danger to you. RECAP So to recap CPR stands for cardiopulmonary resuscitation and should only be performed on someone who’s had a cardiac arrest. If they have, they will appear to be: – Unresponsive, and – Not breathing normally Lesson 5.2 – (Helpful Hints) – What is CPR? Some people fear calling triple zero (000) because they don’t want to get involved because they don’t have an understanding of what first aid is. Please don’t ever do that always know that you can render first aid and help all you need to do is ring Queensland Ambulance Service – Apply First Aid eLearning program 42 Perform CPR through to the Queensland Ambulance service on triple zero (000) speak to an emergency medical dispatcher will ask some questions will get a ambulance out while the Ambulance is proceeding to your location they have qualified instruction, they are qualified to give you instructions so you can render first aid for example if you come across a person that is not breathing then we will teach you how to breath for them if you come across someone who is bleeding we will instruct you on how to stop that bleeding over the phone Lesson 5.3 – How Do I Do CPR? HOW DO I DO CPR? Now that you’ve learnt what CPR is, you can now learn how to use it. Administering CPR slightly varies depending on the age of the casualty. ADULT CPR There are ten steps for administering CPR to an adult. The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. Remember COWS from chapter 3? -­‐ Can you hear me? -­‐ Open your eyes -­‐ What’s your name? -­‐ Squeeze my hands The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. After that, the fourth step is to check the airway. If fluid or vomit is present in the mouth, roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. Partially remove any clothing that may inhibit your ability to perform compressions. Place one hand on the lower half of the sternum with the heel of your hand in the centre and the other hand on top. Push down on their chest to compress their heart. Push one third of their chest depth thirty times at a rate of 100 compressions per minute. The seventh step, tilt the head backwards by placing one hand on the forehead and the other hand on the chin and lift. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. Queensland Ambulance Service – Apply First Aid eLearning program 43 Perform CPR The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself. The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto their side and check they are breathing. Offer reassurance to the casualty and any bystanders. Now, let’s see that demonstration again and make sure you are watching closely to ensure that you understand the correct procedure: 1. Look for danger 2. Check for a response 3. Send for help 4. Clear the airway 5. Check for normal breathing 6. Prepare to resuscitate (CPR) 7. Start compressions 8. Start 2 rescue breaths 9. Repeat compressions and breaths until paramedics arrive, the casualty begins breathing normally and becomes responsive or it becomes impossible for you to continue 10. If the casualty begins breathing normally but remains unresponsive, roll them into the recovery position. CPR FOR CHILDREN AGED 1 TO 8 YEARS OLD Now we’ve covered CPR for an adult, let’s look at CPR for children aged 1 to 8 years old. There are also ten steps for administering CPR for a child: The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. Remember COWS? -­‐ Can you hear me? -­‐ Open your eyes -­‐ What’s your name? -­‐ Squeeze my hands The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. After that, the fourth step is to check the airway. If fluid or vomit is present in the mouth, roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. Queensland Ambulance Service – Apply First Aid eLearning program 44 Perform CPR The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. The critical point for compressions on a child is that you must be able to push one third of their chest depth. Therefore you may need one hand or two hands to do this, dependent on the size of the child. Partially remove any clothing that may inhibit your ability to perform compressions. Place one hand on the lower half of the sternum with the heel of your hand in the centre and the other hand on top. Push down on their chest to compress their heart. Push one third of their chest depth thirty times at a rate of 100 compressions per minute. The seventh step, tilt the head backwards by placing one hand on the forehead and the other hand on the chin and lift. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself. The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto their side and check they are breathing. Offer reassurance to the casualty and any bystanders. INFANT CPR (LESS THAN ONE YEAR OLD) We just covered CPR for a child, now let’s look at CPR for an infant. There are also ten steps for administering CPR to an infant less than one year old. The first step is to check for danger. Ensure safety for yourself, any bystanders and the casualty. The second step is to check for response. DO NOT SHAKE but gently touch and talk to the infant. For example, firmly stroke the infant’s feet. The third step is to call triple zero and ask for an ambulance. Remain calm while answering questions and stay on the phone until you are told to hang up. The fourth step is to check the airway. If fluid or vomit is present in the mouth roll the casualty onto their side, tilt the face downwards and clear the mouth with your fingers. The fifth step is to check for normal breathing. Look and feel for the rise and fall of the chest. Listen and feel for breaths. If the casualty is not breathing normally, prepare for resuscitation. The sixth step is to start compressions. Place two fingers on the centre of the chest and compress one third of the chest depth. Compress thirty times, at a rate of 100 compressions per minute. Partially remove any clothing that may inhibit your ability to perform compressions. Queensland Ambulance Service – Apply First Aid eLearning program 45 Perform CPR The seventh step, place one hand on the forehead and use the other hand to support the chin. DO NOT TILT THE HEAD BACKWARDS. The eighth step is to start rescue breaths. Seal the nose and give two rescue breaths into the mouth, watching for the chest to rise. In an infant a rescue breath more resembles a puff of breath. The ninth step is to repeat compressions and breaths. Repeat 30 chest compressions and 2 rescue breaths. Continue until paramedics take over, the casualty begins breathing normally and becomes responsive, it becomes impossible for you to continue or there is danger to yourself. The tenth and final step is recovery. If the casualty shows signs of recovery, roll them onto side and check they are breathing. Offer reassurances to the infant and any bystanders. RECAP There are ten steps involved with CPR. They are: 1. Check for danger 2. Check response 3. Call triple zero (000) 4. Check airway 5. Check breathing 6. Give 30 chest compressions at a rate of 100 compressions per minute 7. Tilt the head backwards 8. Give two initial rescue breaths or puffs for infants 9. Repeat this sequence until paramedics arrive 10. Recovery, which means rolling the casualty on to their side if they are breathing and offering the casualty reassurance. Lesson 5.3 – (Interactive Activity) – How do you perform CPR? Great you have just learnt about CPR, so it’s time to put yourself to the test in a CPR Activity The purpose of this activity is to practise the ‘delivery’ of the cycles along with the number of compression versus number of breaths and the correct timing to deliver these. You will be simulating the process on Frank our virtual casualty who has kindly volunteered himself for this virtual exercise. Please note: To obtain competency in CPR, you are still required to successfully demonstrate, correct CPR procedures on a real manikin during the practical part of this course. Sorry virtual Frank. Ok click on I agree when you are ready to proceed. Queensland Ambulance Service – Apply First Aid eLearning program 46 Perform CPR How do we use this CPR activity? This virtual CPR activity has two components – Frank will be our casualty The first part is the compression simulation, as you can see displaying Frank’s ribcage. The second part is the breaths simulation, displaying Frank’s cross-­‐section view of his airway. 1.
Compressions, step 1. Place your virtual hands over the correct position on Frank’s chest. A green tick will appear when you have done this correctly. 2.
To simulate compression again use the space bar or click on the compress button in the interface at the required rate. You will notice the pulsing red heart icon. This is the correct rate you should be applying the compressions to. 3.
Clear the casualty’s airway. In this virtual exercise you must perform the following steps to achieve this action. Use the arrows to tilt Frank’s head back then use the other arrow to hold Frank’s jaw out. 4.
To simulate breath resuscitation, press the spacebar or click on the breaths button on the interface to simulate the deliver of the two breaths to the casualty. The 30 compressions and 2 rescue breaths cycle is repeated five times in this virtual CPR activity. The number of cycles preformed are monitored on the cycle counter displayed here. The casualty’s vital signs are monitored by the two status health bars, that simulate the response to your CPR delivery. Naturally, you want to keep the casualty’s health bars in the green zone and you do this by applying CPR correctly. Ok, did you get all that? If you think you ready to begin then click the ‘Start Activity’ button. Lesson 5.3 – (Helpful Hints) – Recovery position As a paramedic there is nothing more frustrating then arriving on a scene seeing a large group of bystanders standing around somebody who is unconscious and lying on there back for whatever reason cardiac arrest or any other reason. As a paramedic over 20 years of service I’ve seen a number of unnecessary deaths where people have been left on there backs they have vomited and there airways have become obstructed and they have died all people have to do is put them in there recovery position or on there side clear there airway until the ambulance arrived and they would have given them an increased chance of surviving. If a patient is in Queensland Ambulance Service – Apply First Aid eLearning program 47 Perform CPR cardiac arrest the important thing to remember is that ultimately you should be doing compressions and ventilations to give the patient or the casualty the best chance of surviving a cardiac arrest. However if you are uncomfortable with doing ventilation or you don’t have a protective barrier because you don’t know that person then compressions are better then nothing at all the Australian resuscitation council highlights clearly that any attempt of CPR is better then none at all. Lesson 5.4 – FAQ’s About CPR Welcome to the Frequently Asked Questions on CPR. Choose the question from this list you’d like to ask, and I’ll answer it for you. So what is the difference between a heart attack and a cardiac arrest? Well, a heart attack (the medical term is a ‘myocardial infarction’) is defined as damage that occurs to the heart muscle when the blood supply in the coronary arteries is blocked and heart tissue does not receive enough oxygen–rich blood. A heart attack may lead to a cardiac arrest when so much of the heart is damaged that it is unable to contract regularly and subsequently stops beating or an abnormal rhythm develops. As there is no way to predict when a heart attack might lead to a cardiac arrest, it is very important to recognise and acknowledge signs and symptoms of a heart attack and seek professional help immediately. When tilting the head backwards, is there any risk of neck injury? Ok, provided common sense and a calm, gentle but firm approach to the head tilt is followed, the chances of making a neck injury worse are outweighed by the benefits of opening the airway. For the majority of casualty’s this will not cause any problems. However, if a neck injury is suspected, as may occur in a road accident or a fall from a height, then neck movements should be kept to a minimum. Is it possible for someone who has no pulse to still be breathing? No, it is not possible. If a pulse is not present, this means the heart has stopped beating and the lungs will not be able to function. Immediately after a cardiac arrest there may appear to be some shallow gasping breaths. This is not normal breathing, and CPR should be commenced immediately. Is it likely that a rib will be injured or broken during chest compressions? It is possible. However, provided common sense and a calm, gentle but firm approach to the compressions are followed, the potential benefits of chest Queensland Ambulance Service – Apply First Aid eLearning program 48 Perform CPR compressions far outweigh any potential for injury. If ribs break during compressions, stop and check your hand positioning and then continue with compressions. Is CPR different if there are multiple first aid providers? No. Frequent rotation of the first aid provider’s, approximately every 2 minutes, is useful to reduce fatigue. When I do rescue breaths is there enough oxygen in my breath to assist the casualty? Yes, the air we breathe in contains about 21% oxygen and the rest is mostly nitrogen. We use only around one quarter of the oxygen in each breath so we are actually breathing out air with about 16% oxygen content. That is still enough to oxygenate the casualty during CPR if carried out effectively. If a person suffering a cardiac arrest does not get CPR, how long does it take before they may sustain brain damage? This will vary according to the age and the general state of health of the casualty prior to the cardiac arrest. The brain is very sensitive to oxygen starvation. After 4 minutes, brain damage is possible. After 6–10 minutes brain damage is likely. Over 10 minutes without oxygen will almost certainly lead to brain damage. To minimize the risk of brain damage, CPR should be commenced immediately. Is it necessary to use any special equipment when doing CPR? You may prefer to use a face shield or resuscitation mask as a barrier between you and the casualty’s mouth during mouth–to–mouth resuscitation. The absence of a face shield should not prevent you from administering rescue breaths. If you are unwilling to do rescue breathing you should do continuous chest compressions only at a rate of 100 per minute. What is the chance of survival for a person suffering a cardiac arrest who gets CPR? CPR alone will not save a life. However, it will increase the casualty’s chance of survival. It is important to recognise that, in some situations, a cardiac arrest will be irreversible, regardless of treatment or intervention. Survival is greatly improved if casualties in receive early bystander CPR and early defibrillation. If I do CPR correctly can I expect the person to spontaneously start breathing or recover before the ambulance arrives? No. CPR assists the casualty by oxygenated blood to the brain and other vital organs. It is rare a person will recover spontaneously before receiving advanced care from the ambulance paramedics. The earlier CPR is administered (even if it isn’t perfect), the greater the chance of survival. Queensland Ambulance Service – Apply First Aid eLearning program 49 Perform CPR Why do I call for an ambulance before starting CPR? CPR on its own will not restart a heart in cardiac arrest. The key treatment for a cardiac arrest is defibrillation, that’s why it is important to ring for an ambulance before starting CPR. This will ensure that a defibrillator will arrive as soon as possible. Remember, a trained emergency medical dispatcher will guide you through CPR, in case you don’t completely remember what to do. What happens when the ambulance arrives? The ambulance service regards a call to a cardiac arrest as the highest priority. The ambulance paramedics will bring a defibrillator with them. The defibrillator is connected to the casualty’s chest and reads electrical activity in the heart. Defibrillation involves giving the heart an electric shock to assist it to return it to a normal rhythm. Can I catch a disease providing CPR? The possibility of disease transmission through CPR is low. However, to overcome any concerns you might have about disease transmission, face shields can be purchased for use in CPR. As most cardiac arrests occur in the home it is very likely that the person requiring CPR will be a spouse, relative or someone known to you. Can I catch a disease from a training manikin? Catching a disease from a manikin is extremely unlikely, providing a few simple precautions are taken. Your first aid instructor will provide you with your own clean manikin facemask at the start of the training session. How do I do rescue breathing on a person with a stoma? A stoma is an artificial airway usually found at the base of the neck... You should place your mouth over the casualty’s stoma and perform rescue breathing as per standard rescue breathing instructions. Do I position a pregnant casualty differently when doing CPR? Yes. Place the pregnant casualty on their back with their right buttock raised. Lesson 5.5 – Introduction to Defibrillation Defibrillation is the fourth link in the chain of survival. The sooner defibrillation is attempted, the more likely a positive result will occur. For every minute a defibrillator is not used, the casualty’s chance of survival decreases by 10%. Queensland Ambulance Service – Apply First Aid eLearning program 50 Perform CPR In an emergency, the first aid provider needs to know how to recognise an emergency, call triple zero (000) and start resuscitation. The next step in the chain of survival is ensuring the casualty is defibrillated as soon as possible. Defibrillation is designed to stop certain dangerous heart rhythms and assist the heart to regain a normal rhythm. If successful, this will result in effective circulation, which will allow oxygen to reach vital organs such as the brain, heart and lungs. The greater the lapse of time before defibrillation is attempted, the less successful it's outcome is likely to be. Until the last few years, paramedics and medical professionals have been the only people to use defibrillators to treat casualties in cardiac arrest. With advanced technology, automated external defibrillators or AED’s as they are commonly known have been developed for use by everyday people like you and me. So how does an AED work? The defibrillation process uses electricity to depolarise (or contract) the entire heart muscle at one time, after which, repolarisation (or resting) of the whole heart muscle occurs. The process effectively stops the heart. Once repolarisation has occurred, it is hoped that the heart’s normal electrical activity will resume. To better understand how an AED works, a basic understanding of the actions of the heart is useful. The pumping action of the heart is called a contraction and it is controlled by the electrical system within the heart. The heart is a double pump. It comprises of four hollow chambers, with the right side separated from the left side by a thin wall. The heart muscle is called the myocardium and it receives its blood supply from the coronary arteries. The term used to describe the death of the myocardium due to the lack of oxygen is myocardial infarction, which is commonly referred to as a heart attack. The heart has two key actions: • Mechanical Action, and • Electrical Action An Electrocardiogram or ECG is a graphic display of the heart’s electrical impulses as they travel through the conduction system. Applying the AED pads to the skin of the chest picks up this electrical activity. A majority of AED’s do not allow the first aid provider to see the ECG display. A normal healthy person will have what’s called a normal sinus rhythm. The two rhythms that can be reversed by defibrillation are: • Ventricular fibrillation (VF) Queensland Ambulance Service – Apply First Aid eLearning program 51 Perform CPR • And pulse less ventricular tachycardia (VT) An AED is used to reverse the effect of cardiac arrest. Remember, if the casualty is not breathing normally or is unresponsive, the casualty is in cardiac arrest. Safety Precautions Before an AED is used on a casualty, a safe working environment must be created. Broadly, there are three areas of danger that must be considered: CONTACT -­‐ No person is to be in either direct or indirect contact with the casualty as time of defibrillation. CONDUCTION – There should be no conductive items in the vicinity of the casualty such as: • Water or rain • Metal or grates • Vomit or blood or perspiration on the chest. EXPLOSION – Do not defibrillate if there is a chance of explosion due to the presence of: • High level of oxygen • Petroleum liquid such as petrol, diesel or Liquid Petroleum Gas (or LPG) • Flammable substances on clothes. AED’s may have their own safety warnings that can show visibly on the display screen, and may emit an audible sound when the AED is turned on. Operating an AED Using an AED is easy. The most important thing to remember is to listen to and obey the voice prompts given by the AED. To operate an AED, follow these steps: • Turn the machine on • Expose the casualty’s chest • Prepare the chest by wiping it dry. If chest hair is present, this should be shaved in the areas where the pads will be placed to ensure proper contact. • Apply the pads in a roll-­‐on fashion to expel air and ensure a good adhesion • Direct those performing CPR to stop • Direct all persons nearby to stand clear • Allow the AED to analyse the heart rhythm • Follow the voice prompts of the AED Queensland Ambulance Service – Apply First Aid eLearning program 52 Perform CPR Should the AED advise that no shock is indicated, the first aid provider should: • Check if the casualty is breathing • If the casualty is not breathing, recommence CPR for two minutes • Stand clear to allow the machine to analyse the casualty’s heart rhythm again. • If the casualty is breathing, move them into the recovery position and continue to monitor their vital signs. Should the AED state that a shock is indicated: • The operator will call ‘stand clear’ and check to ensure there is no contact with the casualty. • The AED voice prompt indicates a shock is to be given. • The shock button will illuminate • Press this button to deliver the shock • The machine will indicate that a shock has been delivered • Follow the machine’s prompts to commence CPR. The machine will reanalyse in two minutes. If the prompts of the machine are obeyed, a successful outcome may be expected without injury to others. In the event of unsuccessful reversion, and when standard protocol is exhausted: • Leave the pads on the casualty • Continue CPR until relieved or exhausted • Care for relatives and loved ones. In the event of successful reversion, when the casualty begins to breathe normally or regains consciousness: • Leave the pads on the casualty • Check casualty’s breathing • If they are not breathing, continue CPR • If they are breathing, check for a response • If they are not responding, place them in the recovery position • If they are responding, place them in a position in which they are more comfortable. If you want to find out more information about AED’s or purchase an AED, please contact us. RECAP So let’s recap: Queensland Ambulance Service – Apply First Aid eLearning program 53 Perform CPR To operate an AED, follow these steps: • Turn the machine on • Expose the causality’s chest • Prepare the chest • Apply the pads in a roll-­‐on fashion to expel air and ensure a good adhesion • Direct those performing CPR to stop • Direct all persons nearby to stand clear • Allow the AED to analyse the heart rhythm • Follow the voice prompts of the AED And when the casualty once again shows signs of life or has a successful reversion: • Leave the pads on the casualty • Check casualty’s breathing • If they are not breathing, continue CPR • If they are breathing, check for a response • If they are not responding, place them in the recovery position • If they are responding, place them in a position in which they are more comfortable. QUIZ That’s the end of the chapter, so you know it’s time to take a quiz. Remember, if you get a question wrong, you can repeat your answer until you get it correct. You will need to successfully complete all questions in this chapter. Ready to go? Queensland Ambulance Service – Apply First Aid eLearning program 54 Perform CPR Conclusion That brings us to the end of the theory component of your accredited course. Remember, you can go back at any time and refresh your knowledge, take the quizzes, watch demonstration videos, participate in the activities or listen to the helpful hints. Now you have successfully completed the theory component of the course, you are ready to enrol in a practical training session. This practical training session will provide you with the opportunity to practise your newly acquired first aid knowledge. On successful completion of the practical training you will be deemed competent and you will achieve an accredited Statement of Attainment. With the knowledge you have gained during this course and the skills you will learn during the practical training component you will be well on your way to offer the best possible assistance, should a life-­‐threatening situation ever occur. Thank you for taking this crucial step in equipping yourself with the knowledge and skills to save lives. Congratulations and good-­‐bye for now. Queensland Ambulance Service – Apply First Aid eLearning program 55